| NPI | 1205049012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301091905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.089074) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2023-07-11 |